Original Research Article
Year: 2019 | Month: February | Volume: 6 | Issue: 2 | Pages: 1-7
Comparative Study on Outcomes of Medical Management versus Combined Surgical and Medical Management of Chronic Rhinosinusitis with Polyps
Kamal Singh Shekhawat1, DK Singh2, Vijay Bhalla3, Salil Kumar Gupta2, Sheetal Raina2, Abha Kumari2
1Junior Resident, 2Assistant Professor, 3Professor,
Department of ENT & HNS, Command Hospital (Eastern Command), Kolkata, West Bengal, India
Corresponding Author: DK Singh
Introduction – In setting of severe scarcity of Indian literature on impact of disease and whether there should be any variation in treatment in view of tropical climate, with this prospective cohort study, we aim to bring some clarity on role of surgery, perioperative management, and its impact on Quality of Life of patients suffering from Chronic Rhinosinusitis with Nasal Polyps (CRSwNP).
Methods – 60 cases of CRSwNP were included as per the inclusion and exclusion criteria of this study. They were randomised into two groups after continued medical management with intranasal corticosteroid sprays (INCS) for 12 weeks. Group A was continued with INCS while Group B was scheduled for Endoscopic Sinus Surgery and postoperatively continued with same medical management. Visual Analogue Scores (VAS), Lund and Mackay endoscopic appearance scores were taken at baseline and on follow ups at 1, 3 and 6 months. Lund and Mackay radiological scores were recorded at baseline and at 6 months.
Results – Mean VAS scores at baseline and 6 months were 6.83 ± 1.12 and 3.83 ± 0.83 for Group A, and 7.27 ± 1.11 and 2.3 ± 0.79 for Group B. Mean Lund and Mackay Endoscopic appearance scores at same follow up period were 8.33 ± 1.03 and 4.73 ± 1.11 for Group A and 8.63 ± 1.13 for Group B. Mean Lund and Mackay Radiological scores at same follow up period were 15.43 ± 1.89 and 9.77 ± 2.56 for Group A and 18.37 ± 3.54 and 2.13 ± 1.28 for Group B. Statistical analysis revealed that there was significant improvement in Group B in terms of all three parameters as compared to Group A.
Conclusion – Carefully selected cases of Chronic Rhinosinusitis with Nasal polyps who have undergone Endoscopic Sinus Surgery with continued medical management with INCS has been proven to have significantly more benefited than those patients who were continued with medical management alone.
Key words: Chronic Rhinosinusitis with Nasal Polyps, Endoscopic Sinus Surgery, VAS scores, Lund and Mackay scoring systems, Intranasal corticosteroid sprays[PDF Full Text]